Co-infection with hepatitis A

Common symptoms can include:

• tiredness
• yellowing of the skin and eyes (known as jaundice)
• pale stools
• dark urine
• nausea and vomiting
• itchy skin
• appetite loss
• fever
• joint and muscle pain.

These symptoms can be made worse by drinking alcohol, tea or coffee and eating fatty food.

Some people have hepatitis A with no symptoms.

People who also have hepatitis B or C may become more seriously ill with hepatitis A, and people with HIV may be ill with hepatitis A for longer.

Find out more about symptoms from NHS Choices.

The infection is spread by contact with infected human faeces (poo), so washing hands after going to the toilet is very important.

Food and water contaminated by faeces from someone infected with hepatitis A are common sources of infection, but it can also be spread during sex, especially by rimming (oral-anal contact). It's rarely spread through blood.

In the UK and Europe there have been outbreaks of hepatitis A among men who have sex with men, so it's important to be aware of ways to prevent transmission.

Good personal hygiene can prevent the transmission of hepatitis A – washing your hands after going to the toilet and before preparing or eating food.

Public Health England recommends the following precautions for men at risk of getting hepatitis A sexually:

• Wash your hands (ideally also your buttocks, groin and penis) after sex.
• Use condoms during sex, changing them if switching between anal and oral sex.
• Don’t share sex toys.
• Use protection if you’re fingering, fisting or rimming someone.

There’s a vaccination against hepatitis A for people travelling to parts of the world where it’s common, have close contact with someone who has the infection, or if you’re a gay man.

The vaccine usually involves two injections, given six months apart, and gives immunity for about 10 years. The length of immunity may be reduced in people living with HIV who have a low CD4 count and an unsuppressed viral load. In cases of people who have a CD4 count below 350, three doses of the vaccination are recommended.

These vaccinations are given at your GP or travel health clinics rather than at sexual health clinics. The vaccination works well in people living with HIV. Everybody who has HIV is recommended to have this vaccine unless they're naturally immune to the infection (meaning that you've had hepatitis A in the past and your body has cleared it) – a test before vaccination can show this.

People who are at a continued risk are advised to have a booster vaccination after 10 years.

If you've been in close contact with someone with hepatitis A, it’s possible to have an injection of antibodies called human normal immunoglobulin (HNIG) combined with the vaccine. You need to have this within two weeks of exposure to hepatitis A.

(This is different from PEP for HIV.)

A blood test can show present or prior hepatitis A infection. Once you've had hepatitis A, you can't get it again. You should be tested for hepatitis A soon after your diagnosis with HIV to see if you might be naturally immune.

You can normally expect to get better without any treatment. NHS Choices recommends doing the following to help manage symptoms:

• get plenty of rest
• stick to a healthy, balanced diet
• eat smaller, lighter meals to avoid feeling sick
• keep cool, wear loose clothing and avoid hot baths and showers to prevent itching
• avoid alcohol.

Paracetamol and ibuprofen can help relieve the pain but this is not advised in case of liver damage, so take a doctor's advice first.

Many anti-HIV drugs (as well as medicines used to treat other conditions) are processed by the liver. It’s very unlikely that you’d have to stop taking your HIV treatment due to liver inflammation caused by hepatitis A. This would only be the case if you were experiencing a severe case of hepatitis A and would be discussed with your doctor.

It's also important to understand how your hepatitis treatment may interact with your HIV medication.